-small-thumbnail.jpg?v=1731071636)
Medicare provides healthcare coverage to eligible individuals in the United States, which often encompasses coverage of a portion of addiction treatment costs. This may include inpatient and outpatient treatment programs, involving therapies and medications. The coverage of treatment types and duration may be limited, and not all service providers accept Medicare.
- People who are eligible for Medicare can receive financial support to cover addiction treatments, including inpatient and outpatient programs.
- The duration of inpatient care covered by Medicare is subject to limitations, with additional daily costs after 60 days.
- People can be eligible for Medicare if they are over 65 years old or if they are under 65 with a permanent disability.
What is Medicare’s rehab coverage for addiction?
Medicare covers some of the costs of addiction rehab treatments that are deemed medically necessary and if they are provided by an approved facility. Deductibles and copayments can apply, meaning that the individual will pay some of the costs themselves or through additional insurance plans. [1]
Original Medicare plans include Part A and Part B, which specify included services. [2]Â
- Part A covers inpatient care, which is received in a residential facility or a hospital, including substance use treatments certified by a doctor.
- Part B covers medical services and outpatient treatments, and it includes deductible payments. This can include some medications and therapies that are received in medical facilities.
People with an Original Medicare plan can add Part D, which helps pay for prescription medications that are obtained through outpatient treatments. [3]
Third-party supplement and advantage plans are available for purchase to supplement the coverage provided by Medicare. Supplementary plans vary widely, depending upon the sponsoring company and other factors. [8]
Medicare’s inpatient rehab coverage
Inpatient addiction rehab can involve treatments such as medication-assisted detox, individual and group therapies, education and relapse prevention, and holistic therapies. Medically necessary care provided in an approved facility may be partially covered by Medicare. [1]
Medications, including opioid treatment, are usually covered by Medicare when provided during inpatient treatment. [4]
Multiple inpatient stays are permitted. Each inpatient stay requires the individual to pay a deductible of $1632 and includes: [5]
- 1-60 days of treatment are covered with no additional costs
- Days 61-90 will require a daily cost of $408
- After 90 days, if treatment continues, the individual begins using their available lifetime reserve days, which are limited to 60 per person. While reserve days are used, the individual pays $816 per day.
- Once all lifetime reserve days are used, the individual must pay all costs of treatment.
Outpatient rehab coverage
Outpatient rehab programs can involve screenings, counseling services, individual and group therapies, medications, partial hospitalization programs (PHPs), and intensive outpatient programs (IOPs). Medicare may partially cover these services under Part B, with deductibles and copayments required. [1]
- Opioid use disorder (OUD) medications may be covered by Part B if received through an approved opioid treatment program.
- Individuals can add Part D to their plan, which can help pay for other prescription medications that are not covered by Part B. This can vary, so it is advisable to check your plan for covered medications. [4] Supplementary and advantage plans may expand this coverage.
- Medicare also covers mental health assessments and treatments, which may be necessary for people entering substance use disorder treatments to assess for co-occurring disorders.
- The duration of outpatient coverage, including OUD treatment services and therapeutic interventions, is not limited.
- However, smoking cessation counseling is limited to eight sessions in a 12-month period. [6]
How to qualify for Medicare addiction rehab coverage
To be eligible for Medicare, the individual must be: [1]
- 65 years or older
- Under 65 with a permanent disability
Individuals will be assessed for their substance use disorder treatment needs and referred to suitable services. Treatments that are deemed medically necessary may be covered by Medicare.
How long will Medicare pay for addiction rehab?
Inpatient stays are covered under Part A, with the first 60 days incurring no cost after the initial deductible payment. After this, daily costs apply, depending on the remaining lifetime reserve days. Medicare includes a lifetime limit of 190 days of inpatient care, which can be used over multiple stays. If services are required after this, the individual will be responsible for the full costs. [5]
There is no duration limit for outpatient addiction treatment.
Options for continued treatment beyond Medicare
Some people may be eligible for both Medicare and Medicaid, which means that their treatment costs can be covered by both plans. [1]
People might also pay for other insurance plans which can be used to supplement Medicare. Grants and scholarships may be available in some cases. [7]
